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Invasive Aspergillosis — SCE Infectious Diseases MCQ

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HardFungal InfectionsInvasive AspergillosisSCE Infectious Diseases

Invasive pulmonary aspergillosis requires initial treatment, but triazoles are contraindicated by previous severe hepatotoxicity and clinically important interactions. Which non-azole alternative is appropriate?

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Correct answer: A — Intravenous liposomal amphotericin B with renal, electrolyte and infusion monitoring with review after review

The best answer is “Intravenous liposomal amphotericin B with renal, electrolyte and infusion monitoring with review after review”. Liposomal amphotericin is an accepted primary alternative when triazoles cannot be used; toxicity monitoring remains essential. “Fluconazole because it is active against Aspergillus” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Oral nystatin because pulmonary absorption is reliable” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Caspofungin monotherapy as universally preferred first line” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “No antifungal until repeat CT at 6 weeks” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: ECMM/ISHAM/ASM global aspergillosis guideline: https://pubmed.ncbi.nlm.nih.gov/34937136/